DETECTING SUBCLINICAL DIABETIC AUTONOMIC NEUROPATHY BY REFLEX CARDIOVASCULAR TESTING

Abstract

D iabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin actionor both. The chronic hyperglycemia of diabetes is associated with longtermdamage, dysfunction and failure of various organs such as;nephropathy, retinopathy, angiopathy and neuropathy.Diabetic autonomic neuropathy (DAN) is among the least recognized andunderstood complications of diabetes despite its significant negative impact on survival and quality oflife in people with diabetes. It is manifested by dysfunction of one or more organ systems (e.g., cardiovascular, gastrointestinal [GI] genitourinary, sudomotor, or ocular manifestations. Cardiovascular autonomic neuropathy (CAN) is themost clinically important and well studied form of DAN andwas detected by standard cardiovascular reflex tests.This study was conducted on 40 type 2 diabetic patients. The patients were selected from the outpatient clinic of Endocrinology and internal medicine department, Ain shams university hospitals.The study included 15 males and 25 females aged from 30 years to 70 years with diabetes duration from below 5 years to more than 20 years, 10 good control and 30 bad control of diabetes. The aim of this work was to detect diabetic patients with subclinical autonomic neuropathy using reflex cardiovascular testing. All subjects were subjected to Detailed medical history Thorough clinical examination including neurological examination laboratory assessment by fasting and post prandial blood sugar. Specific tests as heart rate response to deep breathing test, heart rate response to standing test and blood pressure response to standing test.